Comparison Of Major Liver Transplantation Criterias In World In Predicting Prognosis Of Liver Failure Patients And Research Of The Model For Nontumorous Liver Failure Prognosis

Objective:To compare clinical value of the major liver transplantation criterias in predicting the 3 months survival of liver failure patients and establish a prognostic model for patients with liver failureMethods:The clinical data of 200 cases with liver failure were restrospectively collected.Each case was scored according to the score criterias of Child-Turcotte-Pugh score (CTP),Model for end stage liver disease(MELD),acute physiology and chronic health evaluationⅡ/Ⅲ(APACHEⅡ/Ⅲ)and simplified acute physiology scoreⅡ(SAPSⅡ) systems.Patients were classified into matched group or unmatched group,or different grades according to criterias of King's College Hospital(KCH)and CanWAIT criterias,Japanese liver transplantation(JLT)criteria and Chinese liver transplantation criterias established by Jiefu Huang(Huang's criteria),Shushan Zheng(Zheng's criteria)and Yitao Ding(Ding's criteria).The ability of evaluation was compared with the Receiver Operating Characteristic (ROC)curve according to the golden standard of actual survival or death.The death rate and survival time were compared in different groups of each criteria with the method of Kaplan-Meier survival curve.The independent hazard factors of liver failure prognosis were screened according to single variate and multivariate Cox's proportional hazard model.The model for liver failure prognosis(MLFP)was established according to the independent hazard factors.The clinical value of MLFP was verified by single sample and compared with MELD.Results:1,The CTP score of survival group was 11±1,that of death group 12±1(P＜0.05).The area under the ROC curve(AUC),sensitivity(SN),specificity(SP),positive predictive value(PV+), negative predictive value(PV-)and Youden's index were 0.727,43.18%,91.18%,90.47%, 45.26%and 34.36%,respectively.There were highly significant differences with death rate and survival time between the groups of CTP score above 12 and under 12(P＜0.01).2,The MELD score of survival group was 30±6,that of death group 40±10(P＜0.01).The AUC,SN,SRPV+,PV- and Youden's index were 0.817,62.12%,88.24%,91.11%,54.55%and 50.36%,respectively.There were highly significant differences with death rate and survival time among the groups of MELD score above 36,between 30-36 and under 30(P＜0.01).3,APACHEⅡscore of survival group was 8±4,that of death group 15±7(P＜0.01).The AUC,SN,SP,PV+,PV- and Youden's index were 0.795,59.85%,86.76%,89.77%,52.67% and 46.61%,respectively.There were highly significant differences with death rate and survival time among the groups of APACHEⅡscore above 12,between 8-12 and under 8(P＜0.01).4,APACHEⅢscore of survival group was 42±12,that of death group 65±23(P＜0.01).The AUC,SN,SP,PV+,PV- and Youden's index were 0.827,83.33%,73.53%,85.94%,69.44% and 56.86%,respectively.There were highly significant differences with death rate and survival time between the groups of APACHEⅢscore above 44 and under 44(P＜0.01).5,SAPSⅡscore of survival group was 26±5,that of death group 33±11(P＜0.01).The AUC,SN,SP,PV+,PV- and Youden's index were 0.683,48.48%,85.29%,86.49%,46.03% and 33.77%,respectively.There were highly significant differences with death rate and survival time between the groups of APACHEⅡscore above 30 and under 30(P＜0.01).6,The matched group in KCH was 56 cases,while unmatched group 144.The AUC,SN,SP,PV+,PV- and Youden's index were 0.679,40.15%,95.59%,94.64%,45.14%and 35.74%,respectively.There were highly significant differences with death rate and survival time between the both groups(P＜0.01).7,There were 101 cases in grade2,45 in grade3 and 54 in grade3F according to CanWAIT criteria,respectively.The AUC,SN,SP,PV+,PV- and Youden's index were 0.823,71.21%,92.65%,94.95%,62.38%and 63.86%,respectively.There were highly significant differences with death rate and survival time among the different grades(P＜0.01).8,The matched group in JLT was 85 cases,while unmatched group 115.The AUC,SN,SP, PV+,PV- and Youden's index were 0.755,59.85%,91.18%,92.94%,53.91%and 51.03%, respectively.There were highly significant differences with death rate and survival time between the both groups(P＜0.01).9,The matched group in Huang's criteria were 26,while unmatched group 174.The AUC,SN, SR PV+,PV- and Youden's index were 0.598,19.7%,100%,100%,39.08%and 19.70%,respectively.There were highly significant differences with death rate and survival time between the both groups(P＜0.01).10,The matched group in Zheng's criteria were 37,while unmatched group 163.The AUC, SN,SP,PV+,PV- and Youden's index were 0.607,25.76%,95.59%,91.89%,39.88%and 21.35%,respectively.There were highly significant differences with death rate and survival time between the both groups(P＜0.01).11,The matched group in Ding's criteria were 130,while unmatched group 70.The AUC,SN, SP,PV+,PV- and Youden's index were 0.770,83.33%,70.59%,84.62%,68.57%and 53.92%,respectively.There were highly significant differences with death rate and survival time between the both groups(P＜0.01).12,The independent risk factors of liver failure prognosis by Cox's proportional hazard model were international normalized ratio(INR),serum creatinine(Scr),hepatic encephalopathy (HE)and alimentary tract hemorrhage(ATH)in that order of significance(P＜0.01).The MLFP was etablished using the following formula consisting of the four prognostic factors. MLFP=4.96×LnINR +7.16×LnScr(μmol/L)+9.62×HE(non-HE as 0,HE stageⅠ/Ⅱas 1,HE stageⅢ/Ⅳas 2)+ 6.82×ATH(non-ATH as 0,ATH as 1)(result using integer)13,The results of the single sample verifying the predicting ability of MLFP were AUC0.804,SN78.26%,SP92.85%,PV+90%,PV-83.87%and Youden's index71.11%, respectively.14,MLFP score of the survival group was 40±5,that of death group 53±11(P＜0.01).The AUC,SN,SP,PV+,PV- and Youden's index of MLFP(0.875,76.77%,91.67%,93.70%,76.97% and 68.44%)were higher than those of MELD(AUC0.787,SN63.87%,SP80.21%, PV+83.9%,PV-72.18%and Youden's index 44.08%).There were highly significant differences with death rate and survival time among the groups of MLFP score above 53, between 45-53,40-45 and under 40(P＜0.01). Conclusions:1,The clinical value of CTP score is limitation in liver failure of Chinese patients.The APACHEⅡ/Ⅲand SAPSⅡscore systems have poor practicability,operability in clinical practice.The liver transplantation criterias of KCH,CanWAIT and JLT don't accord with Chinese actuality status.Huang's and Zheng's criterias have lower Youden's index,while Ding's criteria has better Youden's index.But Ding's criteria isn't analysed by statistical method,its clinical value need to be verified further.2,The MELD score is universally used in Europe and America as liver transplantation criteria because its index is simple and has propotional weight with scientific statistical method.3,The independent risk factors of liver failure prognosis include INR,Scr,HE and ATH.4,The MLFP score can predict exactly the 3 months survival of liver failure patients.It has good confidence and manipuility,and its clinical value for liver failure prognosis is better than that of MELD score.The MLFP score can provide scientific evidence for the criteria of liver transplantation recipient for Chinese nontumorous liver failure and waitlisting algorithm of liver failure patients.